Stable Footings for Teams

The first rule of high performing teams is that they must be stable. Given that operating teams are inherently unstable, how do we navigate this problem given the expectation that we be omnipotent in a high volume, high intensity and expectedly emergent clinical work environment? I can only imagine that the answer lies in a few core nuclei: Develop team competencies. Practice and defend them together; Develop systems of work that are fluid, intuitive, simple and antifragile; Develop communication practices that support the logistics of operating theatre workload management, together with decision making algorithms that are reliable, reproducible, and reviewable; Manage fatigue. The most certain way to destroy team fidelity is to impose fatigue on its members; Below Ten Thousand has played with these ideas since before our inception and yet the ideas still seem radical and fantastical. The obstacles for each nucleus of high performance may seem absolute to the uninitiated, but the obstacles are, I assure you, relative obstacles. Absolute obstacles are insurmountable. Relative obstacles are negotiable. The difference is that one is merely a matter of will; a rethink of what is possible. First pass good outcomes inevitably cost less than poor outcomes. The benefits matriculate by many orders of magnitude when you include in the calculation beneficial collateral outcomes. The logic is that, eventually, we must win. We’ve laced our boots for the journey. Pete!

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Below Ten Thousand

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Empowering clinicians in safety culture